Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada
Abstract Background Determining vaccination status among the population is key for vaccine research and surveillance. This study aimed to validate the combined use of Ontario Health Insurance Program (OHIP) physician billing claims and Ontario Drug Benefit program (ODB) pharmacist billing claims aga...
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BMC
2025-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-11014-1 |
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| author | Razan Amoud Jeffrey C. Kwong Colleen Maxwell Suzanne L. Tyas Martin Cooke Alejandro Hernandez Wasem Alsabbagh |
| author_facet | Razan Amoud Jeffrey C. Kwong Colleen Maxwell Suzanne L. Tyas Martin Cooke Alejandro Hernandez Wasem Alsabbagh |
| author_sort | Razan Amoud |
| collection | DOAJ |
| description | Abstract Background Determining vaccination status among the population is key for vaccine research and surveillance. This study aimed to validate the combined use of Ontario Health Insurance Program (OHIP) physician billing claims and Ontario Drug Benefit program (ODB) pharmacist billing claims against data from the Canadian Community Health Survey (CCHS). Methods OHIP and ODB billing claims databases were linked to 2013–2014 CCHS data, which contain self-reported seasonal influenza vaccination status of respondents (the reference standard). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and their associated 95% confidence intervals (CIs) were estimated. Subgroup analyses were performed based on key respondent characteristics, including having a regular medical doctor and the presence of risk factors for influenza complications. Results There were 31,390 eligible CCHS respondents aged ≥ 12 years in Ontario who responded to the influenza vaccination questions and agreed to have their responses linked to health administrative databases. More than half (55%) were female, 29% were aged ≥ 65 years, 93% had a regular medical doctor, and 54% had one or more risk factors for influenza complications. The sensitivity for the combined administrative databases was 60.1% (95% CI, 59.3%–61.0%), specificity was 98.5% (95% CI, 98.3%–98.7%), PPV was 96.7% (95% CI, 96.3%–97.1%), and NPV was 76.9% (95% CI, 76.4%–77.5%). Sensitivity was higher among those aged ≥ 65 years (72.7%; 95% CI, 71.6%–73.7%), with a regular medical doctor (61.1%; 95% CI, 60.3%–62.0%), and those with at least one risk factor for influenza complications (65.8%; 95% CI, 64.9%–66.8%). Conclusion Combining administrative physician and pharmacy claims data in Ontario results in moderate sensitivity but very high specificity and PPV, demonstrating that they can be a valid measure of influenza vaccination status. |
| format | Article |
| id | doaj-art-163fc8a915f44a0993eba7f3c50232dd |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-163fc8a915f44a0993eba7f3c50232dd2025-08-20T03:53:08ZengBMCBMC Infectious Diseases1471-23342025-05-0125111210.1186/s12879-025-11014-1Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, CanadaRazan Amoud0Jeffrey C. Kwong1Colleen Maxwell2Suzanne L. Tyas3Martin Cooke4Alejandro Hernandez5Wasem Alsabbagh6School of Pharmacy, Faculty of Science, University of WaterlooDalla Lana School of Public Health, University of TorontoSchool of Pharmacy, Faculty of Science, University of WaterlooSchool of Public Health Sciences, Faculty of Health, University of WaterlooSchool of Public Health Sciences, Faculty of Health, University of WaterlooICESSchool of Pharmacy, Faculty of Science, University of WaterlooAbstract Background Determining vaccination status among the population is key for vaccine research and surveillance. This study aimed to validate the combined use of Ontario Health Insurance Program (OHIP) physician billing claims and Ontario Drug Benefit program (ODB) pharmacist billing claims against data from the Canadian Community Health Survey (CCHS). Methods OHIP and ODB billing claims databases were linked to 2013–2014 CCHS data, which contain self-reported seasonal influenza vaccination status of respondents (the reference standard). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and their associated 95% confidence intervals (CIs) were estimated. Subgroup analyses were performed based on key respondent characteristics, including having a regular medical doctor and the presence of risk factors for influenza complications. Results There were 31,390 eligible CCHS respondents aged ≥ 12 years in Ontario who responded to the influenza vaccination questions and agreed to have their responses linked to health administrative databases. More than half (55%) were female, 29% were aged ≥ 65 years, 93% had a regular medical doctor, and 54% had one or more risk factors for influenza complications. The sensitivity for the combined administrative databases was 60.1% (95% CI, 59.3%–61.0%), specificity was 98.5% (95% CI, 98.3%–98.7%), PPV was 96.7% (95% CI, 96.3%–97.1%), and NPV was 76.9% (95% CI, 76.4%–77.5%). Sensitivity was higher among those aged ≥ 65 years (72.7%; 95% CI, 71.6%–73.7%), with a regular medical doctor (61.1%; 95% CI, 60.3%–62.0%), and those with at least one risk factor for influenza complications (65.8%; 95% CI, 64.9%–66.8%). Conclusion Combining administrative physician and pharmacy claims data in Ontario results in moderate sensitivity but very high specificity and PPV, demonstrating that they can be a valid measure of influenza vaccination status.https://doi.org/10.1186/s12879-025-11014-1Influenza VaccinationAdministrative Health DataValidationPharmacistImmunization |
| spellingShingle | Razan Amoud Jeffrey C. Kwong Colleen Maxwell Suzanne L. Tyas Martin Cooke Alejandro Hernandez Wasem Alsabbagh Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada BMC Infectious Diseases Influenza Vaccination Administrative Health Data Validation Pharmacist Immunization |
| title | Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada |
| title_full | Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada |
| title_fullStr | Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada |
| title_full_unstemmed | Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada |
| title_short | Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada |
| title_sort | validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in ontario canada |
| topic | Influenza Vaccination Administrative Health Data Validation Pharmacist Immunization |
| url | https://doi.org/10.1186/s12879-025-11014-1 |
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